Improved outcomes with antihypertensive medication in the elderly with isolated systolic hypertension

Isolated systolic hypertension affects over 15% of all individuals aged >60 years. In the elderly, systolic hypertension is a major modifiable cardiovascular risk factor. Systolic blood pressure (SBP) is associated with higher risk of an adverse outcome, whereas diastolic blood pressure (DBP) is inversely correlated with total mortality, independent of SBP, highlighting the role of pulse pressure as a risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment in older patients with isolated systolic hypertension have been published: the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur) Trial and the Systolic Hypertension in China (Syst-China) Trial. These 3 trials demonstrated the benefit of antihypertensive drug treatment. A meta-analysis was performed by pooling the patients from these 3 trials with a subset of patients with isolated systolic hypertension from 5 other trials in the elderly. The pooled results of 15,693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment isjustified if on repeated clinic measurements SBP is 160 mm Hg or higher.     

Syst-Eur--a multicenter trial on the treatment of isolated systolic hypertension in the elderly: first interim report.

Syst-Eur is a multicenter placebo-controlled outcome trial designed by the European Working Party on High Blood Pressure in the Elderly to investigate the effect of antihypertensive treatment on the incidence of stroke in elderly patients with isolated systolic hypertension (ISH). Eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mm Hg with a diastolic blood pressure less than 95 mm Hg. The present paper is an interim report on the first 316 patients randomized into this trial. The placebo (n = 170) and active treatment (n = 146) groups were similar at randomization with respect to age (73 +/- 8 years; mean +/- SD), sitting blood pressure (178 +/- 12 mm Hg systolic; 85 +/- 7 mm Hg diastolic), percentage of men (34%), and percentage of patients with cardiovascular complications (29%). After randomization blood pressure fell more (p less than 0.001) in patients on active treatment than in those in the placebo group (19 +/- 20 mm Hg systolic; 6 +/- 10 mm Hg diastolic vs. 7 +/- 19 and 1 +/- 10 mm Hg for sitting blood pressure). This first interim report on the Syst-Eur trial demonstrates that a multinational trial in elderly patients with ISH is feasible and that a significant blood pressure difference between the two treatment groups can be achieved and maintained. New centers are being recruited in order to randomize a total of 3,000 patients.     

Amélioration des composantes systolique et pulsée de la pression artérielle,de la rigidite artérielle et de l’hypertrophie ventriculaire gauche chez des patients hypertendus traités par l’association perindopril/indapamide. L’étude REASON

Improving the systolic and pulse pressure components of blood pressure, arterial stiffness and left ventricular hypertrophy in hypertensive patients treated with the perindopril/indapamide combination. The REASON Study.It is now well established, particularly in elderly patients, that systolic blood pressure (SBP) levels represent a more reliable predictor than diastolic blood pressure of hypertension-related morbidity and mortality including coronary heart disease, stroke, heart failure, renal insufficiency and cardiovascular death. Adequate control of SBP has therefore become a major objective of antihypertensive therapies. Indeed, despite the recent focus on the systolic blood pressure component in the latest guidelines, systolic hypertension is frequently neglected in clinical practice. Furthermore, several observational studies have suggested that pulse pressure (PP) may be a superior predictor of cardiovascular complications than mean arterial pressure (MAP) levels in certain populations and in elderly patients in particular. Finally, pulse pressure is a marker of large artery stiffness; in risk assessment and risk reduction strategies, pulse pressure and arterial stiffness are strongly associated with vascular alterations and are therefore more closely related to cardiovascular risk. The REASON Study was initiated from these observations.     

社区高血压患者收缩压和脉压差增高与C-反应蛋白的相关性分析

目的探讨社区高血压患者收缩压和脉压差增高与C-反应蛋白之间的相关性。方法选择443例原发性高血压C-反应蛋白升高患者,探讨社区高血压患者收缩压和脉压差增高与C-反应蛋白之间的关系。结果收缩压超过160mmHg、脉压差超过60mmHg、合并糖尿病、合并冠心病及合并高脂血症等为高血压发生的相关危险因素,收缩压超过160mmHg及脉压差超过60mmHg为高血压发生的独立危险因素。结论社区高血压患者收缩压升高和脉压差增大与C-反应蛋白升高存在相关性,炎症反应参与老年高血压收缩压升高和脉压差增大。     

老年与青年高血压病患者脉压和血压变异性比较

目的 比较老年和青年高血压病患者动态血压的差异,为老年高血压病患者的治疗提供依据.方法 我院高血压科就诊的83例2周内未服药的高血压病患者,60岁≤年龄＜80岁患者40例作为老年组,18岁≤年龄≤30岁患者43例作为青年组.2组患者均进行24 h动态血压监测,并比较结果.结果 老年高血压组的动态脉压、动态脉压指数和24h收缩压变异系数明显高于青年高血压组[(61±12) mm Hg(1 mm Hg=0.133 kPa)比(52 ±9)mm Hg,(0.44±0.07)比(0.37±0.06),(11±2)％比(8±2)％,均P＜0.01];24 h平均舒张压和24h平均心率明显低于青年高血压组[(79±10) mm Hg比(88±12)mm Hg,(69±8)次/mint比(74±9)次/min,均P＜0.01].结论 老年高血压病患者主要以动态脉压增大和24h收缩压变异性升高为特点;而青年患者以24h平均舒张压升高为主.因此,临床对老年高血压病患者进行降压治疗时,选择的药物不仅要有效降低平均收缩压水平,还要改善脉压和血压变异性.     

安体舒通对老年单纯收缩期高血压的作用

目的 观察安体舒通对老年单纯收缩期高血压(ISH)患者的影响。方法ISH患者56例,随机分为对照组和治疗组,对照组以硝苯地平控释片30mg,d口服,治疗组在硝苯地平控释片30mg/d口服基础上加用安体舒通60mg/d口服,观察1年。应用偶测血压及动态血压监测参数比较二药对老年ISH血压及其节律的影响。结果二药均可以降低收缩压改善血压节律,但治疗组的作用更显著且能更好地降低脉压。结论安体舒通能降低ISH患者的SBP,显著改善异常的血压节律,有益于老年ISH患者减轻靶器官损害,降低心血管疾病的风险。     

Do we need drug therapy to manage mild hypertension in the elderly?

Mild hypertension (grade 1 or stage 1 hypertension) is defined as a systolic blood pressure of 140-159 mm Hg or a diastolic pressure of 90-99 mm Hg. According to current guidelines, patients with mild hypertension can be at low, medium, high or very high risk depending on the presence of other risk factors, target organ damage and associated cardiovascular or renal conditions. Guidelines recommend prompt initiation of antihypertensive treatment in patients at very high risk because of associated clinical conditions and this recommendation is strongly supported by the literature. Also patients at high risk must be treated without much delay, but it should be mentioned that the evidence is stronger for patients who are at high risk because of diabetes mellitus, than for patients at high risk because of left ventricular hypertrophy or the accumulation of >or = 3 other risk factors. Patients at low and medium risk should be followed up and given advice on nonpharmacological measures and treatment should only be initiated in cases of persistently elevated blood pressure. However, this advice is based on indirect evidence and is currently not supported by randomised controlled trials. A survey on treatment of hypertension and implementation of World Health Organization/International Society of Hypertension (WHO/ISH) guidelines in primary care revealed that, respectively, only 20% and 33% of elderly men with mild hypertension at medium and high risk were treated with antihypertensive drugs and that this prevalence amounted to 67% in patients at very high risk; the prevalence was higher in patients with higher levels of blood pressure in each risk category.     

氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床效果观察

目的分析老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果。方法 96例老年原发性高血压患者,随机分为对照组和观察组,每组48例。对照组采用氢氯噻嗪片治疗,观察组采用氯沙坦钾氢氯噻嗪片治疗。比较两组患者治疗效果及治疗前后血压水平。结果观察组患者的治疗总有效率97.92%高于对照组的85.42%,差异具有统计学意义(P<0.05)。治疗前,两组患者的清晨收缩压(SBP)、舒张压(DBP)及24 h动态SBP、DBP水平比较差异无统计学意义(P>0.05);治疗后,两组患者的清晨SBP、DBP及24 h动态SBP、DBP水平均较治疗前降低,且观察组患者的清晨SBP(135.14±7.04)mm Hg(1 mm Hg=0.133 kPa)、DBP(86.53±6.78)mm Hg及24 h动态SBP(134.24±9.61)mm Hg、DBP(84.81±8.80)mm Hg低于对照组的(140.26±8.17)、(92.06±7.36)、(142.36±9.16)、(89.03±8.05)mm Hg,差异具有统计学意义(P<0.05)。结论老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果比较好,可以明显改善血压水平,具有较高的应用价值。     

老老年与青年高血压病患者血压水平差异的研究

目的 探讨老老年与青年高血压病患者的血压水平差异,以指导老老年患者的临床治疗.方法 选择我院2009年4月至2010年6月高血压科住院的18岁≤年龄≤30岁患者49例作为青年组,≥80岁患者31例作为老老年组.2组患者均做诊室血压测量和24 h动态血压监测,并进行比较.结果 青年组患者诊室测量的舒张压明显高于老老年组[(102±14)mm Hg(1mm Hg=0.133 kPa)比(80±14)mm Hg.P<0.05],老老年组中单纯收缩压升高者明显多于青年组[19例(61.3%)比0例,P<0.01].青年组24 h平均舒张压、24 h平均心率、白昼平均舒张压、夜间平均舒张压均高于老老年组[(81±11)mm Hg比(67±10)mm Hg,(73±11)次/min比(64±15)次/min,(75+28)mm Hg比(59±25)mm Hg,(66±25)mm Hg比(55±23)mm Hg,P<0.05或P<0.01],而24 h脉压低于老老年组[(11±2)mm Hg比(24±4)mm Hg,P<0.01].结论 老老年高血压病患者舒张压、心率低于青年患者,脉压高于青年患者,单纯收缩压升高者明显多于青年患者.老老年高血压病患者应该进行降压治疗,降压药可以首选钙离子拈抗剂和利尿剂.

Abstract：

Objective To discuss the difference of ambulatory blood pressure levels between very elderly and young hypertensives. Methods Eighty inpatients in hypertension department at Anzhen Hospital were enrolled and divided into two groups by age;the young group(49 cases, with age≤30 years old)and very elderly group(31 cases, with age ≥80 years old). Both groups had clinical blood pressure tests and 24-hour ambulatory blood pressure tests, and the outcomes were compared. Results The diastolic blood pressure ( DBP) in the young group is significantly higher than the very elderly group[(102 ±14)mm Hg(l mm Hg =0.133 kPa)vs(80 ±14)mm Hg, P< 0.05]. People simply elevated systolic blood pressure of the very elderly group is significantly more than young group[19 cases(61.3% ) vs 0(0.0% ) , P <0. 01]. The 24 h mean DBP, 24 h mean heart rate, day mean DBP and night mean DBP in young group are higher than the very elderly group[(81 ±11) mm Hg vs(67 ±10) mm Hg, (73 ±ll)beats per minute vs(64 ±15)beats per minute,(75 ±28)mm Hg vs(59 ±25)mm Hg,(66 ±25)mm Hg vs(55 ±23)mm Hg, P<0.05 or P<0.01] , but mean pulse pressure is lower than the very elderly groupf (11 ± 2)mm Hg vs(24 ±5)mm Hg, P<0.01]. Conclusions The DBP and heart rate in the very elderly patients are lower than those in the young patients, while isolated systolic hypertension is significantly higher in the very elderly patients than that in the young patients. The very elderly patients with hypertension should have antihypersive treatment and calcium antagonist as well as diuretic should be the first choices.     

Use of calcium channel antagonists for the treatment of hypertension in the elderly

Systolic blood pressure and pulse pressure increase continuously throughout adult life and the prevalence of arterial hypertension rises accordingly, reaching 53-78% among those aged 65-74 years. Estimates of the prevalence of isolated systolic hypertension in the elderly range from 34-65%, with more women than men affected. It has been shown that within all age groups a difference in usual systolic blood pressure of 20 mm Hg or a difference in usual diastolic blood pressure of 10 mm Hg is associated with an approximately 2-fold difference in the risk of dying from stroke or ischaemic heart disease. Intervention trials using predominantly diuretics and/or beta-adrenoceptor antagonists have proven the efficacy and tolerability of antihypertensive treatment in elderly patients. For many years there have been ongoing discussions about the safety of calcium channel antagonists, especially in patients with diabetes mellitus. However, according to a recently published large prospective, randomised, double-blind, controlled clinical trial with more than 33,000 patients enrolled, no indications for increased total mortality, cancer rate or gastrointestinal bleeding for participants on amlodipine, a long-acting dihydropyridine calcium channel antagonist, were found. With calcium channel antagonists, protective effects against cardiovascular disease have been proven in large trials with elderly patients, particularly against stroke. There is good evidence to suggest that calcium channel antagonists may be superior to other antihypertensive agents in diabetic patients with isolated systolic hypertension. These agents are well tolerated and probably delay the progression of dementia. The lack of adverse metabolic effects that, in the case of a diuretic-based regimen, may have important long-term implications concerning cardiovascular risk, make calcium channel antagonists an attractive choice when antihypertensive treatment decisions need to be made in a predominantly overweight or obese elderly population.     

IS ISOLATED SYSTOLIC HYPERTENSION A WHITE COAT’ PHENOMENON IN THE ELDERLY?

1. Repeated clinic blood pressure measurement was compared with non-invasive ambulatory blood pressure (ABP) monitoring in 10 elderly subjects with isolated systolic hypertension (ISH) and 11 normotensive controls (NT). 2. Subjects were assessed on four occasions at weekly intervals. None was receiving antihypertensive or vasoactive medication. 3. Mean clinic blood pressure was consistently higher than mean daytime ABP in both clinical groups. This effect was greater for systolic (SBP) than diastolic blood pressure (DBP) and in the ISH group compared with the NT group. The reproducibility of the clinic minus ABP difference was high in both groups; the mean +/- s.d. of the differences was 26 +/- 15/9 +/- 2 mmHg in the ISH group and 7 +/- 18/8 +/- 9 mmHg in the controls. 4. ABP readings were normally distributed for both SBP and DBP in both groups. In the ISH group, the frequency distribution of SBP readings was shifted to the right whilst the distribution of DBP readings overlapped that of the NT subjects. 5. These results suggest a pressor response may largely account for the elevated SBP seen in elderly subjects with sustained ISH based on casual readings.     

高血压患者平衡膳食的护理

目的通过对高血压患者进行饮食调查,为饮食护理干预提供依据。方法对120例高血压患者膳食问卷调查,了解膳食危险因素,采用平衡膳食治疗高血压。结果对心内科住院的120例高血压病患者通过饮食指导等非药物措施和药物治疗相结合,25例患者的收缩压下降>20mmHg(1mmHg=0.133kPa)或舒张压下降>10mmHg,40例患者的收缩压下降>10mmHg或舒张压下降5～10mmHg,34例患者的收缩压下降3～10mmHg或舒张压下降1～5mmHg。在医师的指导下,21例患者逐步减少用药剂量或改为单联用药。结论膳食结构不合理是高血压病的重要易患因素之一,饮食治疗亦可配合药物治疗起到良好的压作用,并能减少药物剂量而降低其副作用。     

Trough-to-peak ratio,smoothness index,and circadian blood pressure profile after treatment with once-daily fixed combination of losartan 100 and hydrochlorothiazide 25 in essential hypertension

The once-daily fixed combination of losartan 100 mg/hydrochlorothiazide 25 mg was evaluated for safety and efficacy in a multicenter open study by using 24-h ambulatory blood pressure monitoring in untreated patients with moderate-to-severe essential hypertension or patients with uncontrolled hypertension despite treatment with monotherapy or low-dose combination. After a 2-week washout period, 41 patients (22 men, 19 women) aged 34-74 years, showing a mean daytime blood pressure > 135/85 mm Hg, were treated with losartan 100 mg/hydrochlorothiazide 25 for 8 weeks. Ambulatory blood pressure was monitored at the end of the washout period and during the last week of treatment. A significant reduction in the average values of clinic blood pressure (from 169.9 +/- 13.5 mm Hg to 139.5 +/- 15.6 mm Hg, p < 0.001 for systolic blood pressure [SBP]; and from 102.2 +/- 7.1 mm Hg to 85.1 +/- 9.5 mm Hg, p < 0.001 for diastolic blood pressure [DBP]) was observed after treatment in the whole group of 41 patients. Likewise, average values of both 24-h SBP and 24-h DBP were significantly reduced (from 145.7 +/- 13.1 mm Hg to 128.3 +/- 14.6 mm Hg, p < 0.001 for 24-h SBP; and from 90.3 +/- 7.3 mm Hg to 79.2 +/- 8.6 mm Hg, p < 0.001 for 24-h DBP). The average lowering at peak was 20.2 +/- 11.8 mm Hg for 24-h SBP and 12.1 +/- 7.4 mm Hg for 24-h DBP, whereas the lowering at trough was 17.8 +/- 12.0 mm Hg and 10.4 +/- 8.1 mm Hg, respectively. The trough-to-peak ratio (T/P) was 0.88 for SBP and 0.86 for DBP, and the smoothness index was 7.36 for SBP and 6.37 for DBP. The response rate was 87.8% (blood pressure lowering > 5 mm Hg of either 24-h SBP or 24-h DBP average values). Among responders, T/P ratio was 0.89 for SBP and 0.87 for DBP, and the smoothness index was 8.09 for SBP and 7.15 for DBP. No side effects or changes in metabolic parameters were observed. The fixed combination of losartan 100 mg/hydrochlorothiazide 25 was very effective and well tolerated.     

Epidemiology of hypertension in the elderly.

Epidemiological studies confirm that hypertension, particularly systolic hypertension, is a major cardiovascular and cerebrovascular risk factor in the elderly. Clinical trials convincingly demonstrate the benefits of treating both diastolic hypertension in persons up to age 80 years, and isolated systolic hypertension in persons over age 60. The European Working Party on Hypertension in the Elderly (EWPHE) trial showed that reducing elevated blood pressure resulted in a 27% reduction in overall cardiovascular mortality, as well as significant reductions in severe congestive heart failure, strokes and deaths from myocardial infarction. The Systolic Hypertension in the Elderly Program (SHEP) also reported a 36% reduction in the incidence of stroke and decreases in cardiovascular events, including myocardial infarctions, when hypertension was treated. Additional EWPHE data suggest that the optimal level of systolic blood pressure control is between 146 and 158mm Hg, while patients in the SHEP trial with isolated systolic hypertension derived benefits at an average treated systolic blood pressure of 143mm Hg. Elderly study populations comply well with antihypertensive treatment, and blood pressure can be safely lowered with simple drug regimens. Nonpharmacological treatment is recommended for initial treatment of mild diastolic hypertension and isolated systolic hypertension, and as adjuvant treatment with medication. Since all antihypertensive agents can lower blood pressure in the elderly, therapy should be chosen based on its potential for side effects, drug interactions and effects on concomitant disease states.     

联合用药治疗高龄单纯收缩期高血压的疗效观察

目的探讨非洛地平缓释片联合小剂量美托洛尔加小剂量氢氯噻嗪治疗高龄（≥80岁）老年单纯收缩期高血压（ISH）的降压疗效和安全性。方法选择100例中、高危高龄（≥80岁）老年单纯收缩期高血压（ISH）患者,随机分为试验组和对照组,试验组：给予非洛地平缓释片（5mg,1次/d）;美托洛尔（12.5mg,2次/d）;氢氯噻嗪（12.5mg,2次/d）。对照组：给予硝苯地平缓释片（10mg,2次/d）;美托洛尔（12.5mg,2次/d）,氢氯噻嗪（12.5mg,2次/d）。比较两组治疗前后（2周末）的降压疗效及生化指标变化。结果试验组能显著降低收缩压与脉压,降压疗效试验组为94.0%、对照组为84.0%,两组比较差异有显著（P〈0.05）。两组心率及生化指标与基线值比较差异不显著（P〉0.05）。结论非洛地平缓释片联合小剂量美托洛尔加小剂量氢氯噻嗪能有效降低中、高危高龄（≥80岁）老年ISH患者的血压;以非洛地平缓释片为基础的降压治疗,在高龄（≥80岁）老年单纯收缩期高血压（ISH）的降压治疗中其疗效、安全性、依从性均较高。     

动态血压监测在老年高血压合并靶器官损害中的应用价值

目的：分析动态血压监测（ABPM）在老年高血压合并靶器官损害（TOD）中的应用价值。方法选取我院2012年2月～2013年2月,住院部所收治的老年高血压合并靶器官损害患者共计60例为研究对象,设置为TOD组,选择同期所收治的老年高血压患者共计60例为对照组,设置为非TOD组。分析两组患者血压昼夜节律、变异性值等指标。结果TOD组昼夜血压均值为收缩压（167.23±10.72）mmHg,舒张压（98.32±11.32）mmHg,明显高于非TOD组,差异显著,具有统计学意义（P＜0.01）。两组患者昼夜节律比较,TOD组患者杓型血压23例（38.33%）、非杓型血压37例（61.67%）,差异显著,具有统计学意义（P＜0.01）。TOD组的日间收缩压变异值（16.93±2.34）mmHg,明显高于非TOD组,夜间收缩压变异值为（14.34±6.83）mmHg,明显低于非TOD组,差异显著,具有统计学意义（P＜0.01）。结论血压均值、昼夜节律及其变异性与老年高血压合并靶器官损害紧密相关,动态血压监测在老年高血压合并靶器官损害中具有重要的应用价值。     

厄贝沙坦联合氢氯噻嗪治疗老年原发性高血压的临床观察

目的观察厄贝沙坦联合氢氯噻嗪治疗老年原发性高血压的疗效。方法2012年1月～2013年1月在我院住院治疗的老年原发性高血压患者80例,全部入选对象随机分为观察组和对照组,各40例,对照组予厄贝沙坦、观察组同时联合氢氯噻嗪,比较两组的疗效,并记录治疗前后血压的变化情况及用药期间的不良反应情况。结果观察组的总有效率达95．00％,对照组的总有效率达75．00％,两组疗效比较,差异有统计学意义（P〈0．05）。观察组患者的SBP治疗后达（123．82±14．18）mmHg,DBP（85．18±12．37）mmHg,分别与对照组治疗后的SBP、DBP比较,差异有统计学意义（P〈0．05）。结论厄贝沙坦联合氢氯噻嗪治疗老年原发性高血压疗效确切,可以明显降低患者的收缩压、舒张压,且无明显不良反应,值得推广和应用。     

普伐他汀对老年单纯收缩期高血压患者的血压和血管内皮功能的影响

目的探讨普伐他汀对老年单纯收缩期高血压(ISH)患者的血压及血管内皮功能的影响。方法选取老年ISH患者96例,随机分为对照组和治疗组,对照组给予苯磺酸氨氯地平5mg,每日1次口服,治疗组在此基础上加用普伐他汀20mg,每晚1次口服,疗程1年。分别在治疗前后监测血压、脉压(PP)、血脂的变化,测定血浆一氧化氮(NO)和内皮素-1(ET-1)水平的变化,并采用超声法检测内皮依赖性血管舒张功能(FMD)。结果治疗1年后,两组收缩压(SBP)、舒张压(DBP)及PP与治疗前比较,差异均有统计学意义(P<0.05),治疗组SBP及PP与对照组比较,差异有统计学意义(P<0.05),DBP差异无统计学意义(P>0.05);治疗后两组血脂指标比较,差异有统计学意义(P<0.05);治疗后治疗组NO的水平、FMD明显升高,ET-1的水平明显下降,且与对照组比较差异均有统计学意义(P<0.05)。结论普伐他汀对老年ISH患者有协同降压的作用,且可缩小PP、降低血脂,改善血管内皮功能。     

高血压社区规范化管理效果分析

目的分析380例高血压患者通过社区规范化管理一年后的效果。方法 2011年4月至2012年4月对本院服务辖区建立健康档案的380例原发性高血压病患者进行高血压慢性病规范化管理,经过一年的社区干预管理后,对高血压患者的各项指标进行分析。结果高血压患者收缩压（SBP）和舒张压（DBP）下降显著（P〈0.05）,整体血压水平收缩压平均下降13mmHg,舒张压平均下降幅度为9mmHg,血压控制率从32.1%上升到68.4%;高血压判断标准知晓率由干预前的25%上升到72.4%,显著高于干预前（P〈0.01）。其生活方式（遵医行为、体育锻炼、食盐量、戒烟限酒）明显改善。结论社区规范化管理可以显著控制高血压患者的血压,改善高血压患者的不良习惯,有效提高高血压的知晓率和控制率。     

高血压患者动态血压参数与左室肥厚关系探讨

目的探讨高血压患者动态血压参数与左室肥厚的关系。方法采用无创动态血压仪对102例高血压病患者进行24 h动态血压监测及心脏超声检查,根据左室质量指数（LVMI）分2组：左室肥厚组（n=30）与非左室肥厚组（n=72）。结果（1）左室肥厚组与非左室肥厚组的临床指标比较无统计学意义;（2）左室肥厚组与非左室肥厚组的动态血压参数比较,24 h、白昼、夜间收缩压及脉压以及夜间舒张压有统计学意义（P〈0.05）：24 h平均收缩压分别为（146.2±13.5）mm Hg、（125.7±9.2）mm Hg;24 h脉压分别为（59.7±12.7）mm Hg、（46.8±7.1）mm Hg;白天平均收缩压分别为（149.3±10.9）mm Hg、（128.2±10.64）mm Hg,白天脉压分别为（60.2±12.4）mm Hg、（48.1±8.0）;夜间平均收缩压分别为（141.7±16.9）mm Hg、（118.8±9.7）mm Hg;夜间脉压分别为（57.8±14.1）mm Hg、（43.7±6.7）mm Hg;夜间平均舒张压分别为（84.0±10.7）mm Hg、（75.1±7.6）mm Hg。左室肥厚组与非左室肥厚组其动态血压呈非杓型节律为66.7%比30.6%,其差异有非常显著性（P〈0.01）。结论高血压病动态血压参数异常者左室肥厚发生率高,对靶器官损害有预测价值。